Many times the accounting and billing for medical services rendered, rather than the patient treatment itself, is one the most challenging functions for a doctor's office or other health care provider to perform. Most insurance policies have some form of sharing of the medical costs between the patient and the insurance company utilizing concepts such as deductibles, out of pocket maximums, co-pays, co-insurance, and family versus individual benefits. With the many different concepts and overlapping coverage of the deductibles, co-pays, co-insurance, out of pocket maximums, etc. it can be very difficult for a health care provider to determine the exact amounts owed between the patient and the insurance company. The complexity of calculating the amounts owed is increased due to the contractual relationships between the insurance company and the health care provider. The contractual relationship typically defines the allowable prices that may be charged for different health care products or services.
Due to the complexities of the insurance coverage system as well as the inherent delays in a large, bureaucratic entity such as an insurance company, it may take quite a while to process the insurance and subsequent payments for a health care product or service provided to a health care patient. The patient is normally not billed for their portion of the payment until the final division of payments is determined by the insurance company. Typically, the insurance company does not figure out the final cost divisions until 30 to 90 days after the health care product or service has been provided. Thus, the patient is not billed for up to 30 to 90 days after the health care product or service was provided. Many times, the patient is shocked by the new bill thinking that all of the bills had been paid months earlier. If the patient takes time to protest the charges, the patient may not pay for another 30-180 days, and the health care provider is left waiting for complete payment for 90 to 360 or more days after the health care product or service was provided.